Context
Primary care physicians report high levels of distress, which is linked to burnout, attrition, and poorer quality of care. Programs to reduce burnout before it results in impairment are rare; data on these programs are scarce.Objective
To determine whether an intensive educational program in mindfulness, communication, and self-awareness is associated with improvement in primary care physicians' well-being, psychological distress, burnout, and capacity for relating to patients.Design, Setting, and Participants
Before-and-after study of 70 primary care physicians in Rochester, New York, in a continuing medical education (CME) course in 2007-2008. The course included mindfulness meditation, self-awareness exercises, narratives about meaningful clinical experiences, appreciative interviews, didactic material, and discussion. An 8-week intensive phase (2.5 h/wk, 7-hour retreat) was followed by a 10-month maintenance phase (2.5 h/mo).Main Outcome Measures
Mindfulness (2 subscales), burnout (3 subscales), empathy (3 subscales), psychosocial orientation, personality (5 factors), and mood (6 subscales) measured at baseline and at 2, 12, and 15 months.Results
Over the course of the program and follow-up, participants demonstrated improvements in mindfulness (raw score, 45.2 to 54.1; raw score change [Δ], 8.9; 95% confidence interval [CI], 7.0 to 10.8); burnout (emotional exhaustion, 26.8 to 20.0; Δ = −6.8; 95% CI, −4.8 to −8.8; depersonalization, 8.4 to 5.9; Δ = −2.5; 95% CI, −1.4 to −3.6; and personal accomplishment, 40.2 to 42.6; Δ = 2.4; 95% CI, 1.2 to 3.6); empathy (116.6 to 121.2; Δ = 4.6; 95% CI, 2.2 to 7.0); physician belief scale (76.7 to 72.6; Δ = −4.1; 95% CI, −1.8 to −6.4); total mood disturbance (33.2 to 16.1; Δ = −17.1; 95% CI, −11 to −23.2), and personality (conscientiousness, 6.5 to 6.8; Δ = 0.3; 95% CI, 0.1 to 5 and emotional stability, 6.1 to 6.6; Δ = 0.5; 95% CI, 0.3 to 0.7). Improvements in mindfulness were correlated with improvements in total mood disturbance (r = −0.39, P < .001), perspective taking subscale of physician empathy (r = 0.31, P < .001), burnout (emotional exhaustion and personal accomplishment subscales, r = −0.32 and 0.33, respectively; P < .001), and personality factors (conscientiousness and emotional stability, r = 0.29 and 0.25, respectively; P < .001).Conclusions
Participation in a mindful communication program was associated with short-term and sustained improvements in well-being and attitudes associated with patient-centered care. Because before-and-after designs limit inferences about intervention effects, these findings warrant randomized trials involving a variety of practicing physicians.
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The authors examined the hypothesis that rhesus monkeys with extreme right frontal electroencephalographic activity would have higher cortisol levels and would be more fearful compared with monkeys with extreme left frontal activity. The authors first showed that individual differences in asymmetric frontal electrical activity are a stable characteristic. Next, the authors demonstrated that relative right asymmetric frontal activity and cortisol levels are correlated in animals 1 year of age. Additionally, extreme right frontal animals had elevated cortisol concentrations and more intense defensive responses. At 3 years of age, extreme right frontal animals continued to have elevated cortisol concentrations. These findings demonstrate important relations among extreme asymmetric frontal electrical activity, cortisol levels, and trait-like fear-related behaviors in young rhesus monkeys.
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Meditation can be conceptualized as a family of complex emotional and attentional regulatory training regimes developed for various ends, including the cultivation of well-being and emotional balance. Among these various practices, there are two styles that are commonly studied. One style, focused attention meditation, entails the voluntary focusing of attention on a chosen object. The other style, open monitoring meditation, involves nonreactive monitoring of the content of experience from moment to moment. The potential regulatory functions of these practices on attention and emotion processes could have a long-term impact on the brain and behavior.
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- Practices Specific to Tibetan Buddhism,
- Literature Specific to Tibetan Buddhism,
- Contemplation by Tradition,
- Avalokiteshvara (Chenrezik),
- Means of Accomplishment (sadana, druptap),
- Literature of Buddhist Contemplation,
- Practices of Buddhist Contemplation,
- Generation phase (utpattikrama, kyerim),
- Deity yoga (devata-yoga, lhé nenjor),
- Buddhist Contemplation
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Thirty-two participants were tested for both resting electroencephalography (EEG) and neuropsychological function. Eight one-minute trials of resting EEG were recorded from 14 channels referenced to linked ears, which was rederived to an average reference. Neuropsychological tasks included Verbal Fluency, the Tower of London, and Corsi's Recurring Blocks. Asymmetries in EEG alpha activity were correlated with performance on these tasks. Similar patterns were obtained for delta and theta bands. Factor analyses of resting EEG asymmetries over particular regions suggested that asymmetries over anterior scalp regions may be partly independent from those over posterior scalp regions. These results support the notions that resting EEG asymmetries are specified by multiple mechanisms along the rostral/caudal plane, and that these asymmetries predict task performance in a manner consistent with lesion and neuroimaging studies.
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<p>Drawing its main source of inspiration from a naturalized interpretation of Husserlian phenomenology, On Becoming Aware: A Pragmatics of Experiencing attempts to examine closely the nature of experience and how we may become aware of our own mental life. The authors also focus on how this project fits into the larger context of cognitive science, psychology, neurosciences, and philosophy. Additional partners in the effort to better understand experience are the contemplative systems of the world's spiritual or wisdom traditions, including particularly that of Buddhism. The book includes three separate glossaries of technical terms in phenomenology, the cognitive sciences, and Tibetan Buddhism. The book On Becoming Aware seeks a disciplined and practical approach to exploring human experience. While much of the book draws its inspiration from the phenomenological theories of Husserl, other approaches to the direct study of experience are also explored in depth. One of these approaches is embodied by the world's spiritual or wisdom or contemplative traditions such as Sufism, Buddhism, the Philokalia tradition, and others. Collectively, these traditions have come upon a variety of their own insights and methods for understanding experience, or, to use words from the phenomenological tradition, has developed its own ways of phenomenological reduction Amongst the various wisdom traditions, the authors focus mainly on Buddhism. The authors give an introduction to Buddhist theory and history, followed by an in-depth discussion of the Buddhist contemplative practices of mindfulness, śamatha, vipaśyanā, tonglen (gtong len), lojong (blo sbyong), dzokchen (rdzogs chen), and mahāmudrā. The authors then relate this discussion to themes from philosophy and phenomenology explored earlier in the book, paricularly Husserl's concept of épochè. (Zach Rowinski 2005-01-17) Publisher's description: This book searches for the sources and means for a disciplined practical approach to exploring human experience. The spirit of this book is pragmatic and relies on a Husserlian phenomenology primarily understood as a method of exploring our experience. The authors do not aim at a neo-Kantian a priori ‘new theory’ of experience but instead they describe a concrete activity: how we examine what we live through, how we become aware of our own mental life. The range of experiences of which we can become aware is vast: all the normal dimensions of human life (perception, motion, memory, imagination, speech, everyday social interactions), cognitive events that can be precisely defined as tasks in laboratory experiments (e.g., a protocol for visual attention), but also manifestations of mental life more fraught with meaning (dreaming, intense emotions, social tensions, altered states of consciousness). The central assertion in this work is that this immanent ability is habitually ignored or at best practiced unsystematically, that is to say, blindly. Exploring human experience amounts to developing and cultivating this basic ability through specific training. Only a hands-on, non-dogmatic approach can lead to progress, and that is what animates this book.</p>
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- Science and Buddhist Contemplation,
- Psychology and Contemplation,
- Science and Contemplation,
- Buddhist Contemplation
Background
Early life stress (ELS) can compromise development, with higher amounts of adversity linked to behavioral problems. To understand this linkage, a growing body of research has examined two brain regions involved with socioemotional functioning—amygdala and hippocampus. Yet empirical studies have reported increases, decreases, and no differences within human and nonhuman animal samples exposed to different forms of ELS. This divergence in findings may stem from methodological factors, nonlinear effects of ELS, or both.
Methods
We completed rigorous hand-tracing of the amygdala and hippocampus in three samples of children who experienced different forms of ELS (i.e., physical abuse, early neglect, or low socioeconomic status). Interviews were also conducted with children and their parents or guardians to collect data about cumulative life stress. The same data were also collected in a fourth sample of comparison children who had not experienced any of these forms of ELS.
Results
Smaller amygdala volumes were found for children exposed to these different forms of ELS. Smaller hippocampal volumes were also noted for children who were physically abused or from low socioeconomic status households. Smaller amygdala and hippocampal volumes were also associated with greater cumulative stress exposure and behavioral problems. Hippocampal volumes partially mediated the relationship between ELS and greater behavioral problems.
Conclusions
This study suggests ELS may shape the development of brain areas involved with emotion processing and regulation in similar ways. Differences in the amygdala and hippocampus may be a shared diathesis for later negative outcomes related to ELS.
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Terror management theory posits that people tend to respond defensively to reminders of death, including worldview defense, self-esteem striving, and suppression of death thoughts. Seven experiments examined whether trait mindfulness--a disposition characterized by receptive attention to present experience--reduced defensive responses to mortality salience (MS). Under MS, less mindful individuals showed higher worldview defense (Studies 1-3) and self-esteem striving (Study 5), yet more mindful individuals did not defend a constellation of values theoretically associated with mindfulness (Study 4). To explain these findings through proximal defense processes, Study 6 showed that more mindful individuals wrote about their death for a longer period of time, which partially mediated the inverse association between trait mindfulness and worldview defense. Study 7 demonstrated that trait mindfulness predicted less suppression of death thoughts immediately following MS. The discussion highlights the relevance of mindfulness to theories that emphasize the nature of conscious processing in understanding responses to threat. Keywords: mindfulness, mortality salience, self-determination theory, terror management theory DOI: 10.1037/a0019388
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<p>Mindfulness is an attribute of consciousness long believed to promote well-being. This research provides a theoretical and empirical examination of the role of mindfulness in psychological well-being. The development and psychometric properties of the dispositional Mindful Attention Awareness Scale (MAAS) are described. Correlational, quasi-experimental, and laboratory studies then show that the MAAS measures a unique quality of consciousness that is related to a variety of well-being constructs, that differentiates mindfulness practitioners from others, and that is associated with enhanced self-awareness. An experience-sampling study shows that both dispositional and state mindfulness predict self-regulated behavior and positive emotional states. Finally, a clinical intervention study with cancer patients demonstrates that increases in mindfulness over time relate to declines in mood disturbance and stress.</p>
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<p>A key early fifteenth-century Tibetan historical work that includes all the main schools of Tibetan Buddhism as they existed up to the fifteenth-century, but mainly focused on the Kagyü (bka' brgyud) schools. (BJN)</p>
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